This document provides an overview of cardiovascular biomarkers and their use in disease risk assessment and management. It defines biomarkers and discusses their characteristics. Several specific biomarkers are reviewed in depth, including high-sensitivity C-reactive protein, B-type natriuretic peptide, lipoprotein-associated phospholipase A2, and high-sensitivity troponin. The document concludes by discussing new directions in biomarker research like proteomics and metabolomics, and emphasizes that no single biomarker is sufficient for screening and that biomarker panels may improve risk assessment.
This is a set of powerpoint slides with self-assessment questions interspersed throuought on drug metabolism and pharmacogenetics. The aim is to understand the mechanism of clinically significant drug interactions, recognize potentially clinically significant genetic influences on drug efficacy and toxicity, and genetic predispositions to disease due to altered drug metabolism or transport. This resource is appropriate for medical students or graduate healthcare professionals such as nursing students.
This is a set of powerpoint slides with self-assessment questions interspersed throuought on drug metabolism and pharmacogenetics. The aim is to understand the mechanism of clinically significant drug interactions, recognize potentially clinically significant genetic influences on drug efficacy and toxicity, and genetic predispositions to disease due to altered drug metabolism or transport. This resource is appropriate for medical students or graduate healthcare professionals such as nursing students.
DRUGS AFFECTING THE SODIUM CHANNEL BOTH BLOCKER AND OPENERS, STRUCTURE OF SODIUM CHANNEL AND ITS LOCATION. SODIUM CHANNEL GATTING MECHANISM BY WITCH THEY ACTING. TYPES OF SODIUM CHANNEL AND ITS FUCTIONS. THEIR THERAPEUTIC APPLICATION WITH EXAMPLES OF DRUGS.
This ppt will provide you a brief yet effective information about major types of biomarkers, their definitions, their significance in disease dignosis & treatment, how they are being & are developed to be used as an effective dignostic tool for Cancer & their other future implications in other fields of medicine.
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
Please share this webinar with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
Cancer care is increasingly tailored to individual patients, who can undergo genetic or biomarker testing soon after diagnosis, to determine which treatments have the best chance of shrinking or eliminating tumours.
In this webinar, a pathologist and clinical oncologist discuss:
● how they are using these new tests,
● how they communicate results and treatment options to patients and caregivers, and
● how patients can be better informed on the kinds of tests that are in development or in use across Canada
View the video: https://youtu.be/_Wai_uMQKEQ
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Pharmacogenomics is a new trending branch which has created enormous hopes in improving diagnostic methods, treatment outcomes and preventing adverse events and therapeutic failures. In this ppt basics of pharmacogenomics and pharmacogenetics has been discussed in simplest possible way along with two case studies. Clinical applications of pharmacogenomics has also been discussed in brief.
DRUGS AFFECTING THE SODIUM CHANNEL BOTH BLOCKER AND OPENERS, STRUCTURE OF SODIUM CHANNEL AND ITS LOCATION. SODIUM CHANNEL GATTING MECHANISM BY WITCH THEY ACTING. TYPES OF SODIUM CHANNEL AND ITS FUCTIONS. THEIR THERAPEUTIC APPLICATION WITH EXAMPLES OF DRUGS.
This ppt will provide you a brief yet effective information about major types of biomarkers, their definitions, their significance in disease dignosis & treatment, how they are being & are developed to be used as an effective dignostic tool for Cancer & their other future implications in other fields of medicine.
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
Please share this webinar with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
Cancer care is increasingly tailored to individual patients, who can undergo genetic or biomarker testing soon after diagnosis, to determine which treatments have the best chance of shrinking or eliminating tumours.
In this webinar, a pathologist and clinical oncologist discuss:
● how they are using these new tests,
● how they communicate results and treatment options to patients and caregivers, and
● how patients can be better informed on the kinds of tests that are in development or in use across Canada
View the video: https://youtu.be/_Wai_uMQKEQ
Follow our social media accounts:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Pinterest - https://www.pinterest.com/survivornetwork
YouTube - https://www.youtube.com/user/Survivornetca
Pharmacogenomics is a new trending branch which has created enormous hopes in improving diagnostic methods, treatment outcomes and preventing adverse events and therapeutic failures. In this ppt basics of pharmacogenomics and pharmacogenetics has been discussed in simplest possible way along with two case studies. Clinical applications of pharmacogenomics has also been discussed in brief.
High blood pressure causes many types of cardiovascular disease, such as stroke and heart failure, and renal disease. Peripheral arterial disease (PAD) is caused by atherosclerosis, which is the narrowing and / or blockage of the blood vessels in the legs.
This PPT includes the details about some cardiovascular diseases and how they are treated using Gene Therapy. It also discuss about the vectors that are used in the process.
Studies that examined the therapeutic potential of plants leaf extracts
Plant Scientific Name Common Name Type of extraction Proposed active material
1. Solanum viarum Tropical Soda Apple Ether Solasodine glycoalkaloid
2. Acanthus illicifolious Harkucha Kanta Methanol Triterpenoids,Flavonoids,
Alkaloids
3. Annona squamosa Custard Apple Ethyl acetate Acetogenins,Alkaloids,
Dofamine
4 Alstonia scholaris. Chatium Methanol Alkaloids,Flavonoids
5. Calotropis gigantea Akanda Ethanol Triterpenoids,Flavonol
Glycosides
Brain-type Natriuretic Peptide (BNP) - An Information Resource for Cardiac Ne...NHS Improvement
Brain-type Natriuretic Peptide (BNP) - An Information Resource for Cardiac Networks.
Produced by the NHS Heart Improvement Programme, this online document gives a brief overview of available information on Brain-type Natriuretic Peptide (BNP) testing as a ‘rule-out’ measure for echocardiogram when suspecting a diagnosis of heart failure.
(Updated July 2008).
NAPCRG Pearls: What Is New? The top nine research studies that will impact clinical practice for family physicians as presented by Drs. David Kaplan and David White at Family Medicine Forum in Quebec City, QC Nov 2014
Residual Inflammatory Risk inPatients With Low LDL CholesterolLevels Underg...Shadab Ahmad
Patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) are at high risk of future adverse ischemic events.
Indeed, increased inflammatory status pre- and post-PCI has also been associated with poor prognosis, and control of the residual inflammatory risk (RIR) in the CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) trial has recently opened new perspectives in the field of secondary prevention.
Dyslipidemia and CVS by Mohit Soni and Chandan KumarOlgaGoryacheva4
My students Mohit Soni and Chandan Kumar had presented this topic in our 22nd Student Scientific Society Conference in the department of Propaedeutic of Internal Diseases No.2
Emerging Concepts in Drivers and Regulators of Adaptive ImmunityDr Felipe Templo Jr
This a plenary lecture delivered on day 2 during the 2017 Annual Convention of the Philippine Society of Physiology held on June 1-2, 2017 at FEU-NRMF Institute of Medicine.
Seminar-Workshop on Cardiovascular Pathology; Congenital Heart Disease Part I: Clinical Presentation & Identification of Common Lesions
National Reference Laboratory of Anatomic Pathology for Cardiac Diseases (DOH)
Philippine Heart Center, Quezon City, Philippines.
June 7-8, 2012
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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2. OBJECTIVE:
TO PROVIDE AN OVERVIEW OF RECENT
CONCEPTS AND CLINICAL STUDIES OF
CARDIOVASCULAR BIOMARKERS.
3. WHAT IS A BIOMARKER?
• A BIOMARKER is measurable and quantifiable
biological parameter which serve as indices
for health- and physiology-related
assessments such as disease risk, psychiatric
disorder, environmental exposure and its
effects, disease diagnosis, metabolic
processes, substance abuse, pregnancy, cell
line development, epidemiologic studies, etc
(Medical Subject Heading , 1989)
4. WHAT IS A BIOMARKER?
• A BIOMARKER is a characteristic that is
objectively measured and evaluated as an
indicator or normal biological process,
pathogenic process or pharmacologic
responses to a therapeutic intervention.
These can be measured in a bodily fluid (e.g.
blood or urine)or via medical imaging or
testing (2001, NIH)
5. WHAT IS A BIOMARKER?
A BIOMARKER can be anything that reflects a
biological process-from genetic markers to
imaging tests
SOLUBLE BIOMARKERS are particularly
attractive because they are EASY TO OBTAIN
and generally REPRODUCIBLE
BIOMARKERS within the cardiovascular field
‘frequently’ refer to circulating molecules in
the blood.
6. WHY THERE ARE INTERESTS IN CARDIOVASCULAR
BIOMARKERS FOR PRIMARY PREVENTION?
• 1. Advances if genetic and molecular
researches
• 2. ‘Traditional’ risk factors ( hypertension,
smoking, hyperlipidemia and diabetes) do not
fully explain interindividual variation in
cardiovascular risk.
7. CHARACTERISTICS OF AN IDEAL
(CARDIOVASCULAR) BIOMARKER
• 1. It should easily be measured
• 2. Provides information that in addition to
features that are readily apparent
• 3. Assist in the management of the patient
8. CHARACTERISTICS OF AN IDEAL
(CARDIOVASCULAR) BIOMARKER
• “ Whether a BIOMARKER is used to screen for
a disease, diagnose a disease or inform
prognosis, IT SHOULD AFFECT CLINICAL
MANAGEMENT”- ( Khot UN, JAMA, 2003)
9. GENERAL CONSIDERATIONS IN
EVALUATING NOVEL BIOMARKERS:
• ( 2007,MORROW AND de LEMOS)
• 1. Ease of Measurement- existence of
standardized and reproducible assays
• 2. Addition of Information-incremental
information from measuring a biomarker
• 3. Effect on Management- clinical trials in
primary prevention setting.
11. STATISTICAL ASSESSMENTS
DISCRIMINATION- is the ability of a biomarker to
distinguish those who develop a disease from
those who do not. This can be characterized
by the area under the ROC curve ( AUC) or the
c-statistic
SENSTIVITY- true positive rate
SPECIFICITY- true negative rate
13. STATISTICAL ASSESSMENTS
• RECALIBRATION- refers to the ability of a test to
change an individual’s risk classification. It is based
on risk categories, it is potentially the most clinically
relevant criterion, because treatment decisions are
often linked to whether a patient is considered high
risk or low risk rather than on their specific predicted
event rate.
16. HIGH SENSITIVITY C-REACTIVE
PROTEIN
• Originally discovered by Tillett and Francis in 1930.
• It was found in the serum of patients with acute
inflammation and was noted to react with the C
polysaccharide of pneumococcus,
• An acute-phase reactant, produced primarily by
hepatocytes in response to stimulation from
interlukin-6 and tumor necrosis factor.
• Typically, binds to phosphocholine expressed on the
surface of dead or dying cells and activates the
complement system via the C1Q complex .
17. HIGH SENSITIVITY C-REACTIVE
PROTEIN
• In general, circulating CRP concentrations can
increase up to 50 000–fold in acute inflammation
(i.e., infection) within 6 h.
• CRP typically peaks at 48 h. Because the half-life of
CRP is constant, the degree of increase is determined
by the severity of the precipitating cause
18. HIGH SENSITIVITY C-REACTIVE
PROTEIN
• In the past 15 years, more than 20 epidemiological
studies have demonstrated a significant association
between increased CRP concentrations as measured
by use of high-sensitivity assays (hs-CRP) and the risk
of a first cardiovascular event among asymptomatic
patients.
• A meta-analysis of 22 studies by the US Preventive
Services Task Force indicated that hs-CRP
concentrations greater than or equal to 3 mg/L
were associated with a 60% increased risk of
cardiovascular disease
19. HIGH SENSITIVITY C-REACTIVE
PROTEIN
• In the 2010 American College of Cardiology
Foundation/American Heart Association Guideline
for Assessment of Cardiovascular Risk in
Asymptomatic Adults, the measurement of hsCRP in older men and women with LDL 130 mg/Dl
to aid in the decision to use statins was given a class
Iia recommendation. Overall, measuring hs-CRP for
cardiovascular risk assessment in men 50 years
and women 60 years was given a class Iib
recommendation
20. B-TYPE NATRIURETIC PEPTIDE
• BNP is a member of a family of hormones known as
the natriuretic peptides ,synthesized primarily in the
heart, and upregulated by myocardial wall stress.
• The gene that encodesBNP [natriuretic peptide B
(NPPB)3] initially produces preproBNP.
• PreproBNP is cleaved to form proBNP, a 108–amino
acid peptide precursor.
21. B-TYPE NATRIURETIC PEPTIDE
• proBNP is cleaved by the enzyme corin, forming the
biologically active C-terminal fragment (mature BNP)
as well as the inactive N-terminal fragment (NTproBNP).
• Both BNP and NT-proBNP can be measured in
plasma, the latter has a longer half-life (1–2 h,
compared with 20 min).
22. B-TYPE NATRIURETIC PEPTIDE
• Both BNP and NT-proBNP are markedly increased in
individuals with acute heart failure , which makes
them valuable biomarkers in the setting of suspected
heart failure.
• Framingham Offspring Study, BNP concentrations 20
pg/mL were associated with a 60%–200% increased
risk of cardiovascular events, stroke, heart failure,
and all-cause mortality during a mean follow-up of
5.2 years
23. B-TYPE NATRIURETIC PEPTIDE
• A recent meta-analysis of 40 prospective studies,
approximately half of which were performed in
primary prevention populations, found consistently
strong associations between BNP concentrations and
cardiovascular risk.
• Subtle increases in BNP could reflect increased
ventricular wall stress resulting from subclinical
ischemia, high afterload, or increased
neurohormonal activation.
24. B-TYPE NATRIURETIC PEPTIDE
• There are fewer data on whether BNP
measurements improve discrimination, calibration,
or reclassification for predicting cardiovascular
events, on top of traditional risk factors
25. LIPOPROTEIN-ASSOCIATED
PHOSPHOLIPASE A2
• Lp-PLA2 is a 441–amino acid protein, encoded by the
phospholipase A2, group VII (platelet-activating
factor acetylhydrolase, plasma) (PLA2G7) gene,
which is produced by inflammatory cells.
• It circulates mainly with LDL (20% is associated with
HDL or remnant lipoproteins),and it is responsible for
hydrolyzing oxidized phospholipids in LDL. It
catalyzes the degradation(hydrolysis) of platelet
activating factor to inactive products .
26. LIPOPROTEIN-ASSOCIATED
PHOSPHOLIPASE A2
• It is highly upregulated in atherosclerotic plaques,
and may be directly involved in development of
atherosclerosis and plaque rupture.
• It is produced by macrophages and foam cells in the
vascular intima, Lp-PLA2 is thought to be potentially
more specific for vascular inflammation than other
inflammatory markers, such as CRP.
27. LIPOPROTEIN-ASSOCIATED
PHOSPHOLIPASE A2
• West of Scotland Coronary Prevention Study study,
both hs-CRP and Lp-PLA2 were significantly
associated with increased cardiovascular risk.
• Atherosclerosis Risk in Communities study, the
weighted mean of both Lp-PLA2 and hs-CRP were
higher in those who went on to develop coronary
events than in those who did not
28. HIGH-SENSITIVITY TROPONIN
• In 1963, Ebashi and colleagues discovered that a new
myofibrillar protein, troponin, was integral to both
skeletal and cardiac muscle contraction.
• Cardiac troponins have become the standard
biomarker in the diagnosis of acute myocardial
infarction.
• A troponin concentration above the 99th percentile
(of a healthy population)is considered diagnostic of
an acute myocardial infarction.
29. HIGH-SENSITIVITY TROPONIN
• Newer generations of cardiac troponin I and T
assays, the so called high-sensitivity assays, permit
detection of concentrations significantly lower than
the 99th percentile of the normal reference
population.
• The hstroponin assay, which can detect picomolar
concentrations of troponin, has increased the
sensitivity of acute myocardial infarction diagnosis
and introduced other potential clinical applications
30. HIGH-SENSITIVITY TROPONIN
• 1.de Lemos- hs-troponin T concentrations were
associated with baseline structural heart disease
and all-cause and cardiovascular mortality over 6
years of follow up
• 2. deFilippi-Increased hs-troponin T concentrations
were associated with the development of heart
failure and cardiovascular death.
• 3. Atherosclerosis Risk in Communities study found
that hs-troponin T concentrations were associated
with incident CHD, mortality, and heart failure in
nearly 10000 individuals.
31. Comparisons of Biomarkers
• “NT-proBNP concentrations are more strongly
related to future vascular risk than hs-CRP
concentrations”
• “hs-troponin measurements have predictive
value comparable to NT-proBNP and greater
than hs-CRP”
32. Comparisons of Biomarkers
1. BNP and NT-proBNP strongly predict incident
heart failure risk.
2. hs-CRP and Lp-PLA2 are very good
markers of vascular risk.
3. “Myocardial” biomarkers such as NT-proBNP
and hs-troponin are also surprisingly good
predictors of future vascular events
33. Comparisons of Biomarkers
“Panels of multiple biomarkers appear superior
to individual biomarkers , although the optimal
composition of multi-marker panel
remains to be established”.
35. TAKE HOME MESSAGES
1. Biomarkers hold the promise of earlier and more
accurate cardiovascular risk stratification.
2. Their role in acute cardiovascular diseases, such as
myocardial infarction and heart failure, has been
well studied.
36. TAKE HOME MESSAGES
4. An increasing number of studies have investigated
the role of biomarkers in primary prevention.
5. Future strategies will likely involve larger biomarker
panels and more specific target populations. Larger
panels require new biomarkers that provide
nonoverlapping information to already -available
biomarkers or risk factors. Newer, “unbiased”
approaches,such as proteomics or metabolomics,
show some promise in this regard.
37. TAKE HOME MESSAGES
• 5. No biomarker has emerged as the best screening
marker for cardiovascular disease, and it is likely that
no single biomarker will be sufficiently sensitive or
specific to be used on its own.
• 6. Further studies are also needed to better define
the target populations for biomarker screening,
because a very broad approach maybe unnecessary
as many individuals are adequately risk
stratified by traditional risk factors.